Update: New CMS-588 EFT Form Required for Upcoming CMS Jurisdiction 8 Medicare Contractor Change

Update: As you were notified last month, the Centers for Medicare and Medicaid Services (CMS) has awarded the Medicare Administrative Contractor (MAC) Jurisdiction 8 contract to Wisconsin Physician Services (WPS). Providers who receive their Medicare payments electronically from the current contractor, National Government Services (NGS), for the payers listed below must submit a new CMS-588 Electronic Funds Transfer (EFT) form by June 30, 2012 in order to transition to WPS.

Affected payers include:
CPID 3500 Indiana Medicare Part A
CPID 3515 Michigan Medicare Part A
CPID 1445 Indiana Medicare Part B

Providers can download a blank form from the CMS website by clicking on this link:
http://www.cms.gov/Medicare/CMS-Forms/CMS-Forms/downloads//cms588.pdfCPID 3500 Indiana

Medicare and CPID 3515 Michigan Medicare providers submit the CMS-588 form to:
Regular Mail:
WPS Medicare Part A
Financial Unit
P.O. Box 1602
Omaha, NE 68101

Overnight Address:
WPS Medicare Part A
Financial Unit
3333 Farnam Street
Omaha, NE 68131

CPID 1445 Indiana Medicare providers submit the CMS-588 form to:
Regular Mail:
WPS Medicare Part B
Medicare EFT Unit
P.O. Box 8680
Madison, WI 53708-8680

Overnight Address:
WPS Medicare Part B
Medicare EFT Unit
1717 West Broadway
Madison, WI 53713

Action Required: If you currently receive Medicare payments electronically from NGS, you must submit a new CMS-588 EFT form for the payers listed above.

If you have any questions, please contact Client Services at 1-888-348-8457, option 2.